NOVEL CORONAVIRUS INFECTION (COVID-19): GUIDING PRINCIPLES FOR OBSTETRIC CARE UNDER PANDEMIC CONDITIONS


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Abstract

The literature review analyzes the latest data on the principles of diagnosis and treatment of the novel coronavirus infection, management of pregnancy, childbirth, and the postpartum period during a pandemic, as well as the benefits and risks of breastfeeding with confirmed COVID-19 infection on the basis of the clinical guidelines of the Russian and international professional associations and the results of several basic studies and clinical trials. In late 2019, the global medical community faced the new infection transmitted through airborne droplets. Being initially identified as one of the acute respiratory viral infections, the novel coronavirus infection was included in the list of diseases that pose a risk to others on January 31, 2020. A little later, on March 11, 2020, the World Health Organization (WHO) stated that the infection reached the level of a pandemic. The high-risk group includes the elderly, patients with severe concomitant diseases and immunodeficiency, as well as pregnant women with altered immune responsiveness. At the same time, the pregnancy status restricts the use of some methods for instrumental diagnosis and anti-coronavirus therapy. An obstetrician-gynecologist is responsible not only for the health of an infected woman, but also for that of her unborn child, therefore the specialist must know all the transmission routes of infection, follow epidemiological precautions, be able to identify early symptoms of the disease, perform thorough clinical assessment and provide timely adequate anti-coronavirus therapy. The management of women during pregnancy, childbirth, and postpartum should be carried out according to the potential risk of this infection. The paper provides useful algorithms for actions during the initial hospital admission of a pregnant woman, her further examination and treatment.

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About the authors

Irina V. IGNATKO

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: iradocent@mail.ru
MD, PhD, professor at the Department of Obstetrics, Gynaecology and Perinatology Moscow, Russia

Alexander N. STRIZHAKOV

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: kafedra-agp@mail.ru
Academician of the Russian Academy of Sciences, MD, professor, Head of the Department of Obstetrics, Gynecology and Perinatology, Faculty of Medicine Moscow, Russia

Elena V. TIMOKHINA

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: kafedra-agp@mail.ru
Professor, Doctor of Medical Sciences, Professor of the Department of Obstetrics, Gynecology and Perinatology, Faculty of Medicine Moscow, Russia

Yulia V. DENISOVA

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: yuliya.sheveleva.97@mail.ru
student Moscow, Russia

References

  1. Dong L., Tian J., He S., Zhu C., Wang J., Liu C., Yang J. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020; Mar 26. https://dx.doi.org/10.1001/jama.2020.4621.
  2. Zeng H., Xu C., Fan J., Tang Y., Deng Q., Zhang W., LongX. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA. 2020; Mar 26. https:// dx.doi.org/10.1001/jama.2020.4861.
  3. Chen H., Guo J., Wang C., Luo F., Yu X., Zhang W. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10226): 809-15. https://doi.org/10.1016/S0140-6736(20)30360-3.
  4. Chen Y., Peng H., Wang L., Zhao Y., Zeng L., Gao H., Liu Y. Infants born to mothers with a new coronavirus (COVID-19). Front. Pediatr. 2020; 8: 104. https://dx.doi.org/10.3389/fped.2020.00104.
  5. Li N., Han L., Peng M., Lv Y., Ouyang Y., Liu K. et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin. Infect. Dis. 2020. Mar 30. pii: ciaa352. https://dx.doi.org/10.1093/cid/ ciaa352.
  6. Zhu H., Wang L., Fang C., Peng S., Zhang L., Chang G. et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl. Pediatr. 2020; 9(1): 51-60. https://dx.doi.org/10.21037/tp.2020.02.06.
  7. Liu H., Liu F., Li J., Zhang T., Wang D., Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. J. Infect. 2020; 80(5): e7-e13. https://dx.doi.org/10.1016/j.jinf.2020.03.007.
  8. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). World Health Organisation; 2020.
  9. Guan W.J., Ni Z.Y., Hu Y., Liang W.H., Ou C.Q., He J.X. et al. Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020; 382(18): 1708-20. https://dx.doi.org/10.1056/NEJMoa2002032.
  10. Ashokka B., Loh M.H., Tan C.H., Su L.L., Young B.E., Lye D.C. et al. Care of the pregnant woman with COVID-19 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. Am. J. Obstet. Gynecol. 2020; Apr 10. pii: S0002-9378(20)30430-0. https://dx.doi. org/10.1016/j.ajog.2020.04.005.
  11. Liu D., Li L., Wu X., Zheng D., Wang J., Yang L., Zheng C. Pregnancy and perinatal outcomes of women with coronavirus disease (COVID19) pneumonia: a preliminary analysis. AJR Am. J. Roentgenol. 2020; Mar 18: 1-6. https:// dx.doi.org/10.2214/AJR.20.23072.
  12. NIH COVID-19 Treatment Guidelines. Available at: https:// covid19treatmentguidelines.nih.gov/overview/management-of-covid-19/ Accessed April 22 2020.
  13. Karami P., Naghavi M., Feyzi A., Aghamohammadi M., Novin M.S., Mobaien A. et al. Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings. Travel Med. Infect. Dis. 2020; Apr 11: 101665. https://dx.doi.org/10.1016/ j.tmaid.2020.101665.
  14. Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19. 2020. Available at: https://thrombosisuk. org/covid-19-thrombosis.php Accessed 07 April 2020.
  15. COVID-19: guidance on social distancing and for vulnerable people 2020 Available at: https://www.gov. uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people Accessed 17 March 2020.
  16. Stay at home: guidance for households with possible coronavirus (COVID-19) infection. 2020. Available at: https://www.gov.uk/government/publications/ covid-19-stay-at-home-guidance/stay-at-home-guidancefor-households-with-possible-coronavirus-covid-19-infection Accessed 17 March 2020.
  17. Major new measures to protect people at highest risk from coronavirus. 2020. Available at: https://www. gov.uk/government/news/major-new-measures-to-protect-people-at-highest-risk-from-coronavirus Accessed 26 March 2020.
  18. The Royal College of Obstetricians and Gynaecologists (RCOG). Coronavirus (COVID-19) Infection in Pregnancy. Version 8. London, 2020.
  19. Министерство здравоохранения РФ. Временные методические рекомендации «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)» Минздрава России, версия 7. М.; 2020.
  20. IFMSS. Guidance fetal diagnosis and therapy during COVID-19 pandemic. Leuven; 2020.
  21. Zhou Z., Chen P., Peng H. Are healthy smokers really healthy? Tob. Induc. Dis. 2016; 14: 35. https://dx.doi.org/10.1186/s12971-016-0101-z.
  22. Dowswell T., Carroli G., Duley L., Gates S., Gülmezoglu A.M., Khan-Neelofur D., Piaggio G. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst. Rev. 2015; (7): CD000934. https://dx.doi. org/10.1002/14651858.CD000934.pub3.
  23. Knight M., Bunch K., Tuffnell D., Jayakody H., Shakespeare J., Kotnis R. et al. Saving Lives, Improving Mothers’ Care. Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. MBRRACE-UK; 2018.
  24. Altman D., Carroli G., Duley L., Farrell B., Moodley J., Neilson J., Smith D.; Magpie Trial Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002; 359(9321): 1877-90. https:// dx.doi.org/10.1016/s0140-6736(02)08778-0.
  25. Society for Maternal Fetal Medicine and Society for Obstetric and Anesthesia and Perinatology. Labor and delivery COVID-19 considerations. Available at: https://s3.amazonaws.com/cdn.smfm.- org/media/2277/SMFM- SOAP_COVID_LD_Considerations_3-27- 20_(final)_PDF.pdf Accessed April 1 2020.
  26. World Health Organization. Coronavirus disease (COVID-19) technical guidance: Surveillance and case definitions. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/ technical-guidance/surveillance-and-case-definitions Accessed February 28 2020.
  27. СанПиН 2.6.1.1192-03. Гигиенические требования к устройству и эксплуатации рентгеновских кабинетов, аппаратов и проведению рентгенологических исследований. Утвержденные Главным государственным санитарным врачом Российской Федерации 14 февраля 2003 года, с 1 мая 2003 года.
  28. Juusela A., Nazir M., Gimovsky M. Two cases of COVID-19 related cardiomyopathy in pregnancy. Am. J. Obstet. Gynecol. 2020; 3 April. https:// dx.doi.org/10.1016/j.ajogmf.2020.100113.
  29. Wang M., Cao R., Zhang L., Yang X., Liu J., Xu M. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020; 30(3): 269-71. https://dx.doi.org/10.1038/ s41422-020-0282-0.
  30. Sheahan T.P., Sims A.C., Graham R.L., Menachery V.D., Gralinski L.E., Case J.B. et al. Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses. Sci. Transl. Med. 2017; 9(396). pii: eaal3653. https://dx.doi. org/10.1126/scitranslmed.aal3653.
  31. Mulangu S., Dodd L.E., Davey R.T. Jr., Tshiani Mbaya O., Proschan M., Mukadi D. et al. A randomized, controlled trial of ebola virus disease therapeutics. N. Engl. J. Med. 2019; 381(24): 2293-303. https://dx.doi. org/10.1056/NEJMoa1910993.
  32. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. 2020. Available at: https://www. who.int/publications-detail/clinical-management-of-severeacute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected Accessed 05 March 2020.
  33. Министерство здравоохранения РФ. Организация оказания медицинской помощи беременным, роженицам, родильницам и новорожденным при новой коронавирусной инфекции COVID-19. Методические рекомендации. Версия 1. М.; 24.04.2020.
  34. Updated SOGC Committee Opinion - COVID-19 in Pregnancy (March 13th).
  35. Poon L.C., Yang H., Lee J.C.S., Copel J.A., Leung T.Y., Zhang Y. et al. ISUOG Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals. Ultrasound Obstet. Gynecol. 2020; 55(5): 700-8. https://dx.doi.org/10.1002/ uog.22013.
  36. Ди Ренцо Д.К., Макацария А.Д., Цибизова В.И., Капанна Ф., Разеро Б., Комличенко Э.В., Первунина Т.М., Хизроева Д.Х., Бицадзе В.О., Шкода А.С. О принципах работы перинатального стационара в условиях пандемии коронавируса. Вестник РАМН. 2020; 75(1): 83-92. https://dx.doi. org/10.15690/vramn1324.
  37. Анестезиолого-реанимационное обеспечение пациентов с новой корона-вирусной инфекцией COVID-19. Методические рекомендации. Версия №2 от 18 апреля 2020 года. Общероссийская общественная организация «Федерация анестезиологов и реаниматологов»; 2020. 92с.
  38. Al-Tawfiq J.A., Memish Z.A. Update on therapeutic options for Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Expert Rev. Anti Infect. Ther. 2017; 15(3): 269-75. https://dx.doi.org/10.1080/14787210.2017. 1271712.
  39. Rosjo H., Varpula M., Hagve T.A., Karlsson S., Ruokonen E., Pettilä V., Omland T.; FINNSEPSIS Study Group. Circulating high sensitivity troponin T in severe sepsis and septic shock: distribution, associated factors, and relation to outcome. Intensive Care Med. 2011; 37(1): 77-85. https://dx.doi.org/10.1007/ s00134-010-2051-x.
  40. World Health Organization. Clinical management of severe acute respiratory infection when COVID-19 is suspected. 13 March 2020. Available at: https:// www.who.int/publications-detail/clinicalmanagement-of-severe-acute-respira tory-infection-when-novel-coronavirus-(ncov)-infection-issuspected Accessed March 15 2020.
  41. Swartz D., Graham A. Potential maternal and infant outcomes from coronavirus 2019-nCoV (SARS-CoV-2) infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses. 2020; 12(2). pii: E194. https://dx.doi.org/10.3390/v12020194.
  42. Alserehi H., Wali G., Alshukairi A., Alraddadi B. Impact of Middle East Respiratory Syndrome Coronavirus (MERS - CoV) on pregnancy and perinatal outcome. BMC Infect. Dis. 2016; 16: 105. https://dx.doi.org/10.1186/s12879-016-1437-y.
  43. Dashraath P., Jing Lin Jeslyn W., Mei Xian Karen L., Li Min L., Sarah L., Biswas A. et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am. J. Obstet. Gynecol. 2020; Mar 23. pii: S0002-9378(20)30343-4. https:// dx.doi.org/10.1016/j.ajog.2020.03.021.
  44. National Institute for Health and Care Excellence. Inducing Labour. 2008.
  45. Bohren M.A., Berger B.O., Munthe-Kaas H., Tunçalp Ö. Perceptions and experiences of labour companionship: a qualitative evidence synthesis. Cochrane Database Syst. Rev. 2019; (3): CD012449. https://dx.doi.org/10.1002/14651858. CD012449.pub2.
  46. COVID-19: investigation and initial clinical management of possible cases 2020. Available at: https://www. gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigationand-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection Accessed 05 March 2020.
  47. Chen R., Zhang Y., Huang L., Cheng B.H., Xia Z.Y., Meng Q.T. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can. J. Anaesth. 2020; 67(6): 655-63. https://dx.doi.org/10.1007/s12630-020-01630-7.
  48. Bauer M., Bernstein K., Dinges E., Delgado C., El-Sharawi N., Sultan P. et al. Obstetric Anesthesia during the COVID-19 pandemic. Anesth. Analg. 2020; Apr 6. https://dx.doi.org/10.1213/ANE.0000000000004856.
  49. Puopolo K.M., Hudak M.L., Kimberline D.W., Cummings J. INITIAL GUIDANCE: Management of infants born to mothers with COVID-19. Available at: https://downloads.aap.org/AAP/PDF/ COVID%2019%20Initial%20Newborn%20Guidance.pdf Accessed April 03 2020.
  50. Boelig R.C., Manuck T., Oliver E.A., Di Mascio D., Saccone G., Bellussi F., Berghella V. Labor and delivery guidance for COVID-19. Am. J. Obstet. Gynecol. MFM. 2020. https://dx.doi.org/10.1016/j.ajogmf.2020.100110. Available at: https://www.sciencedirect.com/science/article/pii/S2589933320300409.

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